Eliseo Guallar

Chair and Professor of the Department of Epidemiology

Professional overview

Dr. Guallar is an epidemiologist whose research is focused on the study of cardiovascular disease epidemiology and prevention, with an emphasis on evaluating the role of environmental and nutritional exposures in the development of cardiovascular disease. This research has made critically important and novel contributions to our understanding of risk factors for chronic disease both in the US and globally. He has published seminal articles and is a leading figure in an emerging field highlighting the risks of exposure to levels of metals previously considered safe for cardiovascular health. In addition to his work in toxic metals, Dr. Guallar has made important contributions to understanding the effects of certain micronutrients and vitamin supplements on cardiovascular disease risk and outcomes. Publications in this area were influential in changing consumer habits and attitudes towards these products. Much of this research has been funded by the National Institutes of Health, the Agency for Healthcare Research and Quality, the American Heart Association, the CDC, and other funders.

Dr. Guallar was the founding director of the Center for Clinical Epidemiology at the Samsung Medical Center and a lead investigator of the Kangbuk Samsung Cohort Study at the Kangbuk Samsung Hospital since its inception in 2010. Dr. Guallar has published over 500 research papers in peer-reviewed journals. He is also a Deputy Editor for Methods at the Annals of Internal Medicine and a past member and Chair of the Cancer, Heart, and Sleep Study Section at the National Institutes of Health.

Prior to teaching at NYU, Dr. Guallar was a Professor of Epidemiology and Medicine at the Johns Hopkins University Bloomberg School of Public Health and a core faculty member of the Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins. In the Department of Epidemiology, Dr. Guallar was the Director of the Environmental and Occupational Area of Concentration and the Co-Director of the PhD Program. Dr. Guallar was also an adjunct Professor at the Department of Clinical Research Design and Evaluation of the Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, in Seoul, Korea.

Education

Diploma of English, Spanish Official School of Languages at Zaragoza (Escuela Oficial de Idiomas de Zaragoza), Zaragoza, Spain

MD, University of Zaragoza, Zaragoza, Spain

MPH, University of Minnesota, Minneapolis, MN

DrPH, Harvard University, Boston, MA

Honors and awards

Six Honor Calls in the MD Program, University of Zaragoza School of Medicine (1981)

Fellow of Spain’s Program of Training of Graduate Research of the Ministry of Education and Science, University of Zaragoza (1988)

Fulbright Scholar, sponsored by Spain’s Ministry of Health and Consumer Affairs (1989)

Faculty Innovation Award, Johns Hopkins University Bloomberg School of Public Health (2001)

Scientist Development Award, American Heart Association (2002)

Fellow of the American Heart Association, Council on Epidemiology and Prevention (2013)

Advising, Mentoring, and Teaching Recognition Award 2014 – 2015, Johns Hopkins University Bloomberg School of Public Health (2015)

High Impact Research Icon, University of Malaya (2015)

Publications

Publications

Parathyroid Hormone and Subclinical Cerebrovascular Disease : The Atherosclerosis Risk in Communities Brain Magnetic Resonance Imaging Study

Korada, S. K., Zhao, D., Gottesman, R. F., Guallar, E., Lutsey, P. L., Alonso, A., Sharrett, A. R., Post, W. S., Reis, J. P., Mosley, T. H., & Michos, E. D. (n.d.).

Publication year

2016

Journal title

Journal of Stroke and Cerebrovascular Diseases

Volume

25

Issue

4

Page(s)

883-893

10.1016/j.jstrokecerebrovasdis.2015.12.029

Abstract

Abstract

Background Elevated parathyroid hormone (PTH) levels have been associated with cardiovascular disease risk factors and events. We hypothesized that elevated PTH levels would also be associated with subclinical cerebrovascular disease. We examined the relationship between elevated PTH level and white matter hyperintensities (WMHs) and subclinical infarcts measured on brain magnetic resonance imaging (MRI). Methods PTH was measured at baseline (1993-1994) among participants free of prior clinical stroke who underwent a brain MRI at baseline (n = 1703) and a second brain MRI 10 years later (n = 948). PTH levels of 65 pg/mL or higher were considered elevated (n = 204). Participants who did not return for a follow-up MRI had, at baseline, higher PTH and a greater prevalence of cardiovascular risk factors (P

Patient safety events and harms during medical and surgical hospitalizations for persons with serious mental illness

Daumit, G. L., McGinty, E. E., Pronovost, P., Dixon, L. B., Guallar, E., Ford, D. E., Cahoon, E. K., Boonyasai, R. T., & Thompson, D. (n.d.).

Publication year

2016

Journal title

Psychiatric Services

Volume

67

Issue

10

Page(s)

1068-1075

10.1176/appi.ps.201500415

Abstract

Abstract

Objective: This study explored the risk of patient safety events and associated nonfatal physical harms and mortality in a cohort of persons with serious mental illness. This group experiences high rates of medical comorbidity and premature mortality and may be at high risk of adverse patient safety events. Methods: Medical record reviewwas conducted formedicalsurgical hospitalizations occurring during 1994-2004 in a community-based cohort of Maryland adults with serious mental illness. Individuals were eligible if they died within 30 days of a medical-surgical hospitalization and if they also had at least one prior medical-surgical hospitalization within five years of death. All admissions took place at Maryland general hospitals. A case-crossover analysis examined the relationships among patient safety events, physical harms, and elevated likelihood of death within 30 days of hospitalization. Results: A total of 790 hospitalizations among 253 adults were reviewed. The mean number of patient safety events per hospitalization was 5.8, and the rate of physical harms was 142 per 100 hospitalizations. The odds of physical harm were elevated in hospitalizations in which 22 of the 34 patient safety events occurred (p

Patterns and Implications of Intracranial Arterial Remodeling in Stroke Patients

Qiao, Y., Anwar, Z., Intrapiromkul, J., Liu, L., Zeiler, S. R., Leigh, R., Zhang, Y., Guallar, E., & Wasserman, B. A. (n.d.).

Publication year

2016

Journal title

Stroke

Volume

47

Issue

2

Page(s)

434-440

10.1161/STROKEAHA.115.009955

Abstract

Abstract

Background and Purpose - Preliminary studies suggest that intracranial arteries are capable of accommodating plaque formation by remodeling. We sought to study the ability and extent of intracranial arteries to remodel using 3-dimensional high-resolution black blood magnetic resonance imaging and investigate its relation to ischemic events. Methods-Forty-two patients with cerebrovascular ischemic events underwent 3-dimensional time-of-flight magnetic resonance angiography and contrast-enhanced black blood magnetic resonance imaging examinations at 3 T for intracranial atherosclerotic disease. Each plaque was classified by location (eg, posterior versus anterior circulation) and its likelihood to have caused a stroke identified on magnetic resonance imaging (culprit, indeterminate, or nonculprit). Lumen area, outer wall area, and wall area were measured at the lesion and reference sites. Plaque burden was calculated as wall area divided by outer wall area. The arterial remodeling ratio (RR) was calculated as outer wall area at the lesion site divided by outer wall area at the reference site after adjusting for vessel tapering. Arterial remodeling was categorized as positive if RR >l 1.05, intermediate if 0.95≤RR≤1.05, and negative if RR < 0.95. Results-One hundred and thirty-seven plaques were identified in 42 patients (37% [50] posterior and 63% [87] anterior). Compared with anterior circulation plaques, posterior circulation plaques had a larger plaque burden (77.7±15.7 versus 69.0±14.0; P=0.008), higher RR (1.14±0.38 versus 0.95±0.32; P=0.002), and more often exhibited positive remodeling (54.0% versus29.9%; P=0.011). Positive remodeling was marginally associated with downstream stroke presence when adjusted for plaque burden (odds ratio 1.34, 95% confidence interval: 0.99-1.81). Conclusions-Intracranial arteries remodel in response to plaque formation, and posterior circulation arteries have a greater capacity for positive remodeling and, consequently, may more likely elude angiographic detection. Arterial remodeling may provide insight into stroke risk.

Peripheral arterial disease and its association with arsenic exposure and metabolism in the strong heart study

Newman, J. D., Navas-Acien, A., Kuo, C. C., Guallar, E., Howard, B. V., Fabsitz, R. R., Devereux, R. B., Umans, J. G., Francesconi, K. A., Goessler, W., Best, L. T., & Tellez-Plaza, M. (n.d.).

Publication year

2016

Journal title

American Journal of Epidemiology

Volume

184

Issue

11

Page(s)

806-817

10.1093/aje/kww002

Abstract

Abstract

At high levels, inorganic arsenic exposure is linked to peripheral arterial disease (PAD) and cardiovascular disease. To our knowledge, no prior study has evaluated the association between low-to-moderate arsenic exposure and incident PAD by ankle brachial index (ABI). We evaluated this relationship in the Strong Heart Study, a large population-based cohort study of American Indian communities. A total of 2,977 and 2,966 PAD-free participants who were aged 45-74 years in 1989-1991 were reexamined in 1993-1995 and 1997-1999, respectively, for incident PAD defined as either ABI 1.4. A total of 286 and 206 incident PAD cases were identified for ABI 1.4, respectively. The sum of inorganic and methylated urinary arsenic species (∑As) at baseline was used as a biomarker of long-term exposure. Comparing the highest tertile of ∑As with the lowest, the adjusted hazard ratios were 0.57 (95% confidence interval (CI): 0.32, 1.01) for ABI 1.4. Increased arsenic methylation (as percent dimethylarsinate) was associated with a 2-fold increased risk of ABI >1.4 (hazard ratio = 2.04, 95% CI: 1.02, 3.41). Long-term low-to-moderate ∑As and increased arsenic methylation were associated with ABI >1.4 but not with ABI

Persistent Nonalcoholic Fatty Liver Disease Increases Risk for Carotid Atherosclerosis

Sinn, D. H., Cho, S. J., Gu, S., Seong, D., Kang, D., Kim, H., Yi, B. K., Paik, S. W., Guallar, E., Cho, J., & Gwak, G. Y. (n.d.).

Publication year

2016

Journal title

Gastroenterology

Volume

151

Issue

3

Page(s)

481-488.e1

10.1053/j.gastro.2016.06.001

Abstract

Abstract

Background & Aims Nonalcoholic fatty liver disease (NAFLD) has been associated with subclinical atherosclerosis in cross-sectional studies. We investigated the longitudinal association of NAFLD with the development of subclinical carotid atherosclerosis. Methods We performed a retrospective cohort study of 8020 adult men (average age, 49.2 y) without carotid atherosclerosis at baseline who underwent repeated health check-up examinations from January 1, 2005, through December 31, 2013. NAFLD status was diagnosed by ultrasonography and classified into 4 groups based on baseline and follow-up findings: none, developed, regressed, or persistent NAFLD. Subclinical carotid atherosclerosis was measured by ultrasound. Results The age-adjusted hazard ratio for subclinical carotid atherosclerosis development comparing participants with persistent NAFLD with those without NAFLD was 1.23 (95% confidence interval [CI], 1.13–1.35; P

Physical Activity, Parental History of Premature Coronary Heart Disease, and Incident Atherosclerotic Cardiovascular Disease in the Atherosclerosis Risk in Communities (ARIC) Study

Florido, R., Zhao, D., Ndumele, C. E., Lutsey, P. L., Mcevoy, J. W., Windham, B. G., Pankow, J. S., Guallar, E., & Michos, E. D. (n.d.).

Publication year

2016

Journal title

Journal of the American Heart Association

Volume

5

Issue

9

10.1161/JAHA.116.003505

Abstract

Abstract

Background: The effects of some atherosclerotic cardiovascular disease (ASCVD) risk factors vary according to whether an individual has a family history (FHx) of premature coronary heart disease (CHD). Physical activity (PA) is associated with reduced risk of ASCVD, but whether this association varies by FHx status is not well established. Methods and Results: We evaluated 9996 participants free of ASCVD at baseline. FHx of premature CHD was defined as CHD occurring in a father before age 55 or mother before age 60. PA, assessed by a Baecke questionnaire, was converted into minutes/week of moderate or vigorous exercise and categorized per American Heart Association guidelines as recommended, intermediate, or poor. Incident ASCVD was defined as incident myocardial infarction, fatal CHD, or stroke. Multivariable-adjusted Cox hazard models were used. The mean age was 54±6 years, 56% were women, and 21% of black race. Participants with and without a FHx of premature CHD reported similar levels of PA at baseline (423 versus 409 metabolic equivalents of task×min/week, respectively, P=0.852), and ≈40% of both groups met American Heart Association recommended PA levels. Over a mean follow-up of 20.9 years, there were 1723 incident ASCVD events. Compared to those with poor PA adherence to American Heart Association guidelines, participants who reported PA at recommended levels had significantly lower risk of incident ASCVD after adjustment for demographics and lifestyle factors (hazard ratio 0.84, 95% CI 0.74-0.94), but this association was not modified by FHx status (P-interaction=0.680). Conclusions: PA was associated with a reduced risk of ASCVD among individuals with and without a FHx of premature CHD.

Polyunsaturated fats, carbohydrates and carotid disease : The Atherosclerosis Risk in Communities (ARIC) Carotid MRI study

Dearborn, J. L., Qiao, Y., Guallar, E., Steffen, L. M., Gottesman, R. F., Zhang, Y., & Wasserman, B. A. (n.d.).

Publication year

2016

Journal title

Atherosclerosis

Volume

251

Page(s)

361-366

10.1016/j.atherosclerosis.2016.05.024

Abstract

Abstract

Background and aims Carbohydrates and fat intake have both been linked to development of atherosclerosis. We examined associations between glycemic index (GI) and fat intake with carotid atherosclerosis. Methods The Atherosclerosis Risk in Communities (ARIC) cohort enrolled participants during the period 1987–1989 and the Carotid MRI sub-study occurred between 2004 and 2006 (1672 participants attending both visits). Measures of carbohydrate quality (usual GI), fat intake (total, polyunsaturated and saturated) and overall dietary quality index (DASH Diet Score) were derived from a 66-item food frequency questionnaire administered at baseline. Trained readers measured lipid core presence and maximum wall thickness. Using multivariate logistic regression, we determined the odds of lipid core presence by quintile (Q) of energy-adjusted dietary components. Restricted cubic spline models were used to examine non-linear associations between dietary components and maximum wall thickness. Results Mean daily polyunsaturated fat intake was 5 g (SD 1.4). GI and polyunsaturated fat intake had a nonlinear relationship with maximum wall thickness. Low (1–4 g) and high (6–12 g) polyunsaturated fat intake were associated with a statistically significant decreased odds of lipid core presence compared to intake in a majority of participants (OR Q5 vs. Q2-4: 0.64, 95% CI 0.42 to 0.98; OR Q1 vs. Q2-4: 0.64, 95% CI 0.42, 0.96), however, the association with lipid core was attenuated by adjustment for maximum wall thickness, hypertension, hyperlipidemia, and diabetes. Conclusions GI and polyunsaturated fat intake were not associated with high-risk plaque features, such as lipid core presence, independent of traditional vascular risk factors.

Prevalence of glaucoma in the united states : The 2005–2008 national health and nutrition examination survey

Gupta, P., Zhao, D., Guallar, E., Ko, F., Boland, M. V., & Friedman, D. S. (n.d.).

Publication year

2016

Journal title

Investigative Ophthalmology and Visual Science

Volume

57

Issue

6

Page(s)

2905-2913

10.1167/iovs.15-18469

Abstract

Abstract

PURPOSE. To estimate the prevalence of glaucoma in the US population based on optic nerve head photography, to estimate the prevalence of glaucoma awareness, and to identify demographic and ocular risk factors for being unaware of having glaucoma. METHODS. The study included 5746 men and women 40 years of age and older participating in the National Health and Nutrition Examination Survey (NHANES) 2005–2008. Each participant had 458 photographs of the macula and optic disc of both eyes. Fundus photographs were first graded by a reading center, and those with a cup-to-disc ratio (CDR) ≥ 0.6 were regraded by three glaucoma specialists to determine the presence or absence of glaucoma. Analyses were performed using NHANES weights to account for the complex multistage probability sampling design. RESULTS. The estimated overall prevalence of glaucoma in the US civilian, noninstitutionalized population 40 years of age and older was 2.1% (95% confidence interval [CI], 1.7%–2.6%). Glaucoma affected 2.9 million individuals, including 1.4 million women; 1.5 million men; 2.3 million people 60 years of age and older; and 0.9 million blacks, Mexican Americans, and people of other races. The prevalence of glaucoma was highest in non-Hispanic blacks, followed by non-Hispanic whites, Mexican Americans, and others. Over half of participants with glaucoma were unaware that they had the disease. CONCLUSIONS. The prevalence of glaucoma based on optic nerve fundus photography assessment in the general US population 40 years of age and older was 2.1%. Approximately half of glaucoma cases were previously undiagnosed. Studies to determine whether and how to identify undiagnosed glaucoma are an important next step.

Prevalence of Intracranial Atherosclerotic Stenosis Using High-Resolution Magnetic Resonance Angiography in the General Population : The Atherosclerosis Risk in Communities Study

Suri, M. F., Qiao, Y., Ma, X., Guallar, E., Zhou, J., Zhang, Y., Liu, L., Chu, H., Qureshi, A. I., Alonso, A., Folsom, A. R., & Wasserman, B. A. (n.d.).

Publication year

2016

Journal title

Stroke

Volume

47

Issue

5

Page(s)

1187-1193

10.1161/STROKEAHA.115.011292

Abstract

Abstract

Background and Purpose - Intracranial atherosclerotic stenosis (ICAS) is a common cause of stroke, but little is known about its epidemiology. We studied the prevalence of ICAS and its association with vascular risk factors using high-resolution magnetic resonance angiography in a US cardiovascular cohort. Methods - The Atherosclerosis Risk in Communities (ARIC) study recruited participants from 4 US communities from 1987 to 1989. Using stratified sampling, we selected 1980 participants from visit 5 (2011-2013) for high-resolution 3T-magnetic resonance angiography. All images were analyzed in a centralized laboratory, and ICAS was graded as: no stenosis,

Response to Letter Regarding Article, "Patterns and Implications of Intracranial Arterial Remodeling in Stroke Patients"

Qiao, Y., Guallar, E., & Wasserman, B. A. (n.d.).

Publication year

2016

Journal title

Stroke

Volume

47

Issue

5

Page(s)

e87

10.1161/STROKEAHA.116.012970

Abstract

Abstract

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Serum amine-based metabolites and their association with outcomes in primary prevention implantable cardioverter-defibrillator patients

Zhang, Y., Blasco-Colmenares, E., Harms, A. C., London, B., Halder, I., Singh, M., Dudley, S. C., Gutmann, R., Guallar, E., Hankemeier, T., Tomaselli, G. F., & Cheng, A. (n.d.).

Publication year

2016

Journal title

Europace

Volume

18

Issue

9

Page(s)

1383-1390

10.1093/europace/euv342

Abstract

Abstract

Aims Heart failure patients are at increased risk of ventricular arrhythmias and all-cause mortality. However, existing clinical and serum markers only modestly predict these adverse events.We sought to use metabolic profiling to identify novel biomarkers in two independent prospective cohorts of patients with implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death (SCD). Methods and results Baseline serum was quantitatively profiled for 42 known biologically relevant amine-based metabolites among 402 patients from the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD) Study (derivation group) and 240 patients from the Genetic Risk Assessment of Defibrillator Events (GRADE) Study (validation group) for ventricular arrhythmia-induced ICD shocks and all-cause mortality. Three amines, N-methyl-Lhistidine, symmetric dimethylarginine (SDMA), and L-kynurenine, were derived and validated to be associated with all-cause mortality. The hazard ratios of mortality in PROSE-ICD and GRADE were 1.48 (95% confidence interval 1.14-1.92) and 1.67 (1.22-2.27) for N-methyl-L-histidine, 1.49 (1.17-1.91) and 1.77 (1.27-2.45) for SDMA, 1.31 (1.06-1.63) and 1.73 (1.32-2.27) for L-kynurenine, respectively. L-Histidine, SDMA, and L-kynurenine were associated with ventricular arrhythmia-induced ICD shocks in PROSE-ICD, but they did not reach statistical significance in the GRADE cohort. Conclusion Utilizing metabolic profiling in two independent prospective cohorts of patients undergoing ICD implantation for primary prevention of SCD, we identified several novel amine markers that were associated with appropriate shock and mortality. These findings shed insight into the potential biologic pathways leading to adverse events in ICD patients. Further studies are needed to confirm the prognostic value of these findings.

Serum-based oxylipins are associated with outcomes in primary prevention implantable cardioverter defibrillator patients

Zhang, Y., Guallar, E., Blasco-Colmenares, E., Harms, A. C., Vreeken, R. J., Hankemeier, T., Tomaselli, G. F., & Cheng, A. (n.d.).

Publication year

2016

Journal title

PloS one

Volume

11

Issue

6

10.1371/journal.pone.0157035

Abstract

Abstract

Introduction: Individuals with systolic heart failure are at risk of ventricular arrhythmias and all-cause mortality. Little is known regarding the mechanisms underlying these events. We sought to better understand if oxylipins, a diverse class of lipid metabolites derived from the oxidation of polyunsaturated fatty acids, were associated with these outcomes in recipients of primary prevention implantable cardioverter defibrillators (ICDs). Methods: Among 479 individuals from the PROSE-ICD study, baseline serum were analyzed and quantitatively profiled for 35 known biologically relevant oxylipin metabolites. Associations with ICD shocks for ventricular arrhythmias and all-cause mortality were evaluated using Cox proportional hazards models. Results: Six oxylipins, 17,18-DiHETE (HR = 0.83, 95% CI 0.70 to 0.99 per SD change in oxylipin level), 19,20-DiHDPA (HR = 0.79, 95% CI 0.63 to 0.98), 5,6-DiHETrE (HR = 0.73, 95% CI 0.58 to 0.91), 8,9-DiHETrE (HR = 0.76, 95% CI 0.62 to 0.95), 9,10-DiHOME (HR = 0.81, 95% CI 0.65 to 1.00), and PGF1α (HR = 1.33, 95% CI 1.04 to 1.71) were associated with the risk of appropriate ICD shock after multivariate adjustment for clinical factors. Additionally, 4 oxylipin-to-precursor ratios, 15S-HEPE / FA (20:5-ω3), 17,18-DiHETE / FA (20:5-ω3), 19,20-DiHDPA / FA (20:5-ω3), and 5S-HEPE / FA (20:5-ω3) were positively associated with the risk of all-cause mortality. Conclusion: In a prospective cohort of patients with primary prevention ICDs, we identified several novel oxylipin markers that were associated with appropriate shock and mortality using metabolic profiling techniques. These findings may provide new insight into the potential biologic pathways leading to adverse events in this patient population.

Shock Index as a Predictor of Myocardial Injury in ST-segment Elevation Myocardial Infarction

Hwang, J. K., Jang, W. J., Song, Y. B., Lima, J. A., Guallar, E., Choe, Y. H., Choi, S., Kim, E. K., Hahn, J. Y., Choi, S. H., Lee, S. C., & Gwon, H. C. (n.d.).

Publication year

2016

Journal title

American Journal of the Medical Sciences

Volume

352

Issue

6

Page(s)

574-581

10.1016/j.amjms.2016.09.003

Abstract

Abstract

Background: Little is known about the association between shock index and myocardial injury in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: We analyzed cardiac magnetic resonance imaging from 306 consecutive patients treated with primary PCI for STEMI. The patients were divided into the following 2 groups: initial shock index >0.7 (n = 88) and ≤0.7 (n = 218). Shock index was calculated as the ratio of heart rate to systolic blood pressure based on the first recorded vital signs upon arrival. The primary end point was myocardial infarct size. Results: The shock index >0.7 group, exhibited a lower baseline left ventricular ejection fraction (P = 0.01), higher N-terminal prohormone of brain natriuretic peptide level (P = 0.01), higher Killip class (P < 0.01) and higher prevalence of diabetes (P = 0.02) than the shock index ≤0.7 group. There were no significant differences in the angiographic or procedural characteristics between the 2 groups. In cardiac magnetic resonance imaging analysis, the shock index >0.7 group had a larger infarct size than did the shock index ≤0.7 group (22.9 ± 11.2% versus 19.2 ± 11.5%, P < 0.01). According to multivariate analysis, shock index >0.7 was associated with large myocardial infarctions (odds ratio = 3.02; 95% CI: 1.62-5.65; P < 0.01). Conclusions: Initial shock index is a potentially reliable predictor of myocardial injury in patients with STEMI undergoing primary PCI.

Sugar-sweetened carbonated beverage consumption and coronary artery calcification in asymptomatic men and women

Chun, S., Choi, Y., Chang, Y., Cho, J., Zhang, Y., Rampal, S., Zhao, D., Ahn, J., Suh, B. S., Pastor-Barriuso, R., Lima, J. A., Chung, E. C., Shin, H., Guallar, E., & Ryu, S. (n.d.).

Publication year

2016

Journal title

American Heart Journal

Volume

177

Page(s)

17-24

10.1016/j.ahj.2016.03.018

Abstract

Abstract

Background Sugar-sweetened carbonated beverage consumption has been linked to obesity, metabolic syndrome, type 2 diabetes, and clinically manifest coronary heart disease, but its association with subclinical coronary heart disease remains unclear. We investigated the relationship between sugar-sweetened carbonated beverage consumption and coronary artery calcium (CAC) in a large study of asymptomatic men and women. Methods This was a cross-sectional study of 22,210 adult men and women who underwent a comprehensive health screening examination between 2011 and 2013 (median age 40 years). Sugar-sweetened carbonated beverage consumption was assessed using a validated food frequency questionnaire, and CAC was measured by cardiac computed tomography. Multivariable-adjusted CAC score ratios and 95% CIs were estimated from robust Tobit regression models for the natural logarithm (CAC score +1). Results The prevalence of detectable CAC (CAC score >0) was 11.7% (n = 2,604). After adjustment for age; sex; center; year of screening examination; education level; physical activity; smoking; alcohol intake; family history of cardiovascular disease; history of hypertension; history of hypercholesterolemia; and intake of total energy, fruits, vegetables, and red and processed meats, only the highest category of sugar-sweetened carbonated beverage consumption was associated with an increased CAC score compared with the lowest consumption category. The multivariable-adjusted CAC ratio comparing participants who consumed ≥5 sugar-sweetened carbonated beverages per week with nondrinkers was 1.70 (95% CI, 1.03-2.81). This association did not differ by clinical subgroup, including participants at low cardiovascular risk. Conclusion Our findings suggest that high levels of sugar-sweetened carbonated beverage consumption are associated with a higher prevalence and degree of CAC in asymptomatic adults without a history of cardiovascular disease, cancer, or diabetes.

The association between blood pressure and lipid levels in Europe : European study on cardiovascular risk prevention and management in usual daily practice

Borghi, C., Rodriguez-Artalejo, F., De Backer, G., Dallongeville, J., Medina, J., Guallar, E., Perk, J., Banegas, J. R., Tubach, F., Roy, C., & Halcox, J. P. (n.d.).

Publication year

2016

Journal title

Journal of Hypertension

Volume

34

Issue

11

Page(s)

2155-2163

10.1097/HJH.0000000000001078

Abstract

Abstract

Objectives: Several studies have suggested a positive association between serum lipid levels and blood pressure (BP). This study investigated this association in a large population from 12 European countries. Methods: Data were taken from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (ClinicalTrials.gov identifier: NCT00882336). Associations between BP and lipid levels in patients free from cardiovascular disease and with at least one major cardiovascular disease risk factor (N=7641) were assessed using linear regression analyses. Results: Overall, 72.8 and 64.8% of patients had hypertension and dyslipidaemia, respectively; 47.0% had both conditions. Regression coefficients (95% confidence interval) for the associations of LDL cholesterol, non-HDL cholesterol, total cholesterol and apolipoprotein B levels with SBP, adjusted for age, sex and BMI, were 0.93 mmHg/mmol per l (0.54-1.31), 1.07 mmHg/mmol per l (0.73-1.40), 1.02 mmHg/mmol per l (0.69-1.35) and 4.94 mmHg/g per l (3.43-6.46), respectively. The corresponding values (95% confidence interval) for the associations with DBP were 0.96 mmHg/mmol per l (0.73-1.19), 0.95 mmHg/mmol per l (0.75-1.15), 0.87 mmHg/mmol per l (0.67-1.07) and 4.33 mmHg/g per l (3.42-5.23), respectively. Most of these associations remained significant whether patients were treated with statins or not. Conclusion: Small but statistically significant associations between lipid levels and BP were observed in a large, multinational European population. Further research is warranted to assess the causality of this association and its implications on the management of patients with both hypertension and dyslipidaemia.

Vitamin D deficiency is independently associated with greater prevalence of erectile dysfunction : The National Health and Nutrition Examination Survey (NHANES) 2001–2004

Farag, Y. M., Guallar, E., Zhao, D., Kalyani, R. R., Blaha, M. J., Feldman, D. I., Martin, S. S., Lutsey, P. L., Billups, K. L., & Michos, E. D. (n.d.).

Publication year

2016

Journal title

Atherosclerosis

Volume

252

Page(s)

61-67

10.1016/j.atherosclerosis.2016.07.921

Abstract

Abstract

Background and aims Erectile dysfunction (ED) and atherosclerotic cardiovascular disease (ASCVD) share many common risk factors, and vascular ED is a marker for increased ASCVD risk. Low 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with increased ASCVD risk, but less is known regarding the relationship of low 25(OH)D with ED. We determined whether 25(OH)D deficiency is associated with ED independent of ASCVD risk factors. Methods We performed cross-sectional analyses of 3390 men aged ≥20 years free of ASCVD who participated in NHANES 2001–2004. Serum 25(OH)D was measured by the DiaSorin radioimmunoassay; deficiency was defined as levels

ω-3 Polyunsaturated fatty acid biomarkers and coronary heart disease : Pooling project of 19 cohort studies

Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Fatty Acids and Outcomes Research Consortium (FORCe), A., Del Gobbo, L. C., Imamura, F., Aslibekyan, S., Marklund, M., Virtanen, J. K., Wennberg, M., Yakoob, M. Y., Chiuve, S. E., Dela Cruz, L., Frazier-Wood, A. C., Fretts, A. M., Guallar, E., Matsumoto, C., Prem, K., Tanaka, T., Wu, J. H., Zhou, X., Helmer, C., … Mozaffarian, D. (n.d.).

Publication year

2016

Journal title

JAMA internal medicine

Volume

176

Issue

8

Page(s)

1155-1166

10.1001/jamainternmed.2016.2925

Abstract

Abstract

Importance: The role of ω-3 polyunsaturated fatty acids for primary prevention of coronary heart disease (CHD) remains controversial. Most prior longitudinal studies evaluated self-reported consumption rather than biomarkers. Objective: To evaluate biomarkers of seafood-derived eicosapentaenoic acid (EPA; 20:5 ω-3), docosapentaenoic acid (DPA; 22:5 ω-3), and docosahexaenoic acid (DHA; 22:6 ω-3) and plant-derived α-linolenic acid (ALA; 18:3 ω-3) for incident CHD. Data Sources: A global consortium of 19 studies identified by November 2014. Study Selection: Available prospective (cohort, nested case-control) or retrospective studies with circulating or tissue ω-3 biomarkers and ascertained CHD. Data Extraction and Synthesis: Each study conducted standardized, individual-level analysis using harmonized models, exposures, outcomes, and covariates. Findings were centrally pooled using random-effects meta-analysis. Heterogeneity was examined by age, sex, race, diabetes, statins, aspirin, ω-6 levels, and FADS desaturase genes. Main Outcomes and Measures: Incident total CHD, fatal CHD, and nonfatal myocardial infarction (MI). Results: The 19 studies comprised 16 countries, 45 637 unique individuals, and 7973 total CHD, 2781 fatal CHD, and 7157 nonfatal MI events, with ω-3 measures in total plasma, phospholipids, cholesterol esters, and adipose tissue. Median age at baselinewas 59 years (range, 18-97 years), and 28 660 (62.8%)were male. In continuous (per 1-SD increase) multivariable-adjusted analyses, the ω-3 biomarkers ALA, DPA, and DHAwere associated with a lower risk of fatal CHD, with relative risks (RRs) of 0.91 (95%CI, 0.84-0.98) for ALA, 0.90 (95%CI, 0.85-0.96) for DPA, and 0.90 (95%CI, 0.84-0.96) for DHA. Although DPA was associated with a lower risk of total CHD (RR, 0.94; 95%CI, 0.90-0.99), ALA (RR, 1.00; 95%CI, 0.95-1.05), EPA (RR, 0.94; 95%CI, 0.87-1.02), and DHA (RR, 0.95; 95%CI, 0.91-1.00)were not. Significant associations with nonfatal MIwere not evident. Associations appeared generally stronger in phospholipids and total plasma. Restricted cubic splines did not identify evidence of nonlinearity in dose responses. Conclusions and Relevance: On the basis of available studies of free-living populations globally, biomarker concentrations of seafood and plant-derived ω-3 fatty acids are associated with a modestly lower incidence of fatal CHD.

Ambient air pollution and racial/ethnic differences in carotid intima-media thickness in the Multi-Ethnic Study of Atherosclerosis (MESA)

Jones, M. R., Diez-Roux, A. V., O'Neill, M. S., Guallar, E., Sharrett, A. R., Post, W., Kaufman, J. D., & Navas-Acien, A. (n.d.).

Publication year

2015

Journal title

Journal of Epidemiology and Community Health

Volume

69

Issue

12

Page(s)

1191-1198

10.1136/jech-2015-205588

Abstract

Abstract

Background In the USA, ethnic disparities in atherosclerosis persist after accounting for known risk factors. Ambient air pollution is associated with increased levels of atherosclerosis and differs in the USA by race/ethnicity. We estimated the influence of ambient air pollution exposure to ethnic differences in common carotid intima-media thickness (IMT). Methods We cross-sectionally studied 6347 Caucasian- American, African-American, Hispanic and Chinese adults across 6 US cities in 2000-2002. Annual ambient air pollution concentrations (fine particulate matter [PM2.5] and oxides of nitrogen [NOX]) were estimated at each participant's residence. IMT was assessed by ultrasound. Results The mean IMT was 19.4 and 37.6 μm smaller for Hispanic women and men, 53.6 and 7.1 μm smaller for Chinese women and men, and 23.4 and 38.7 μm higher for African-American women and men compared with Caucasian-American women and men. After adjustment for PM2.5, the differences in IMT remained similar for Hispanic and African-American participants but was even more negative for Chinese participants (mean IMT difference of -58.4 μm for women and -15.7 μm for men) compared with Caucasian-American participants. The IMT difference in Chinese participants compared with Caucasian-American participants related to their higher PM2.5 exposures was 4.8 μm (95% CI 0.2 to 10.8) for women and 8.6 μm (95% CI 3.4 to 15.3) for men. NOX was not related to ethnic differences in IMT. Conclusions The smaller carotid IMT levels in Chinese participants were even smaller after accounting for higher PM2.5 concentrations in Chinese participants compared with Caucasian-American participants. Air pollution was not related to IMT differences in African-American and Hispanic participants compared with Caucasian-American participants.

Arsenic exposure, arsenic metabolism, and incident diabetes in the strong heart study

Kuo, C. C., Howard, B. V., Umans, J. G., Gribble, M. O., Best, L. G., Francesconi, K. A., Goessler, W., Lee, E., Guallar, E., & Navas-Acien, A. (n.d.).

Publication year

2015

Journal title

Diabetes Care

Volume

38

Issue

4

Page(s)

620-627

10.2337/dc14-1641

Abstract

Abstract

OBJECTIVE Little is known about arsenic metabolism in diabetes development. We investigated the prospective associations of low-moderate arsenic exposure and arsenic metabolism with diabetes incidence in the Strong Heart Study. RESEARCH DESIGN AND METHODS A total of 1,694 diabetes-free participants aged 45-75 years were recruited in 1989-1991 and followed through 1998-1999. We used the proportions of urine inorganic arsenic (iAs), monomethylarsonate (MMA), and dimethylarsinate (DMA) over their sum (expressed as iAs%, MMA%, and DMA%) as the biomarkers of arsenic metabolism. Diabetes was defined as fasting glucose ≥126 mg/dL, 2-h glucose ≥200 mg/dL, self-reported diabetes history, or self-reported use of antidiabetic medications. RESULTS Over 11,263.2 person-years of follow-up, 396 participants developed diabetes. Using the leave-one-out approach to model the dynamics of arsenic metabolism, we found that lower MMA% was associated with higher diabetes incidence. The hazard ratios (95% CI) of diabetes incidence for a 5% increase inMMA% were 0.77 (0.63-0.93) and 0.82 (0.73-0.92) when iAs% and DMA%, respectively,were left out of the model. DMA% was associated with higher diabetes incidence only when MMA% decreased (left out of the model) but not when iAs% decreased. iAs% was also associated with higher diabetes incidence when MMA% decreased. The association between MMA% and diabetes incidence was similar by age, sex, study site, obesity, and urine iAs concentrations. CONCLUSIONS Arsenicmetabolism, particularly lowerMMA%,was prospectively associated with increased incidence of diabetes. Research is needed to evaluate whether arsenic metabolism is related to diabetes incidence per se or through its close connections with one-carbon metabolism.

Arsenic exposure, hyperuricemia, and gout in US adults

Kuo, C. C., Weaver, V., Fadrowski, J. J., Lin, Y. S., Guallar, E., & Navas-Acien, A. (n.d.).

Publication year

2015

Journal title

Environment international

Volume

76

Page(s)

32-40

10.1016/j.envint.2014.11.015

Abstract

Abstract

There is very limited information on the association between arsenic and serum uric acid levels or gout. The aim of this study was to investigate the association of arsenic with hyperuricemia and gout in US adults. Methods: A cross-sectional study was conducted in 5632 adults aged 20. years or older from the National Health and Nutrition Examination Survey (NHANES) 2003-2010 with determinations of serum uric acid and urine total arsenic and dimethylarsinate (DMA). Hyperuricemia was defined as serum uric acid higher than 7.0. mg/dL for men and 6.0. mg/dL for women. Gout was defined based on self-reported physician diagnosis and medication use. Results: After adjustment for sociodemographic factors, comorbidities and arsenobetaine levels, the increase in the geometric means of serum uric acid associated with one interquartile range increase in total arsenic and DMA levels was 3% (95% CI 2-5) and 3% (2-5), respectively, in men and 1% (0-3) and 2% (0-4), respectively, in women. In men, the adjusted odds ratio for hyperuricemia comparing the highest to lowest quartiles of total arsenic was 1.84 (95% CI, 1.26-2.68) and for DMA it was 1.41 (95% CI, 1.01-1.96). The corresponding odds ratios in women were 1.26 (0.77, 2.07) and 1.49 (0.96, 2.31), respectively. The odds ratio for gout comparing the highest to lowest tertiles was 5.46 (95% CI, 1.70-17.6) for total arsenic and 1.98 (0.64-6.15) for DMA among women older than 40. years old. Urine arsenic was not associated with gout in men. Conclusion: Low level arsenic exposures may be associated with the risk of hyperuricemia in men and with the prevalence of gout in women. Prospective research focusing on establishing the direction of the relationship among arsenic, hyperuricemia, and gout is needed.

Association between body mass index and cortical thickness : Among elderly cognitively normal men and women

Kim, H., Kim, C., Seo, S. W., Na, D. L., Kim, H. J., Kang, M., Shin, H. Y., Cho, S. K., Park, S. E., Lee, J., Hwang, J. W., Jeon, S., Lee, J. M., Kim, G. H., Cho, H., Ye, B. S., Noh, Y., Yoon, C. W., & Guallar, E. (n.d.).

Publication year

2015

Journal title

International Psychogeriatrics

Volume

27

Issue

1

Page(s)

121-130

10.1017/S1041610214001744

Abstract

Abstract

Background: There is increasing evidence of a relationship between underweight or obesity and dementia risk. Several studies have investigated the relationship between body weight and brain atrophy, a pathological change preceding dementia, but their results are inconsistent. Therefore, we aimed to evaluate the relationship between body mass index (BMI) and cortical atrophy among cognitively normal participants. Methods: We recruited cognitively normal participants (n = 1,111) who underwent medical checkups and detailed neurologic screening, including magnetic resonance imaging (MRI) in the health screening visits between September 2008 and December 2011. The main outcome was cortical thickness measured using MRI. The number of subjects with five BMI groups in men/women was 9/9, 148/258, 185/128, 149/111, and 64/50 in underweight, normal, overweight, mild obesity, and moderate to severe obesity, respectively. Linear and non-linear relationships between BMI and cortical thickness were examined using multiple linear regression analysis and generalized additive models after adjustment for potential confounders. Results: Among men, underweight participants showed significant cortical thinning in the frontal and temporal regions compared to normal weight participants, while overweight and mildly obese participants had greater cortical thicknesses in the frontal region and the frontal, temporal, and occipital regions, respectively. However, cortical thickness in each brain region was not significantly different in normal weight and moderate to severe obesity groups. Among women, the association between BMI and cortical thickness was not statistically significant. Conclusions: Our findings suggested that underweight might be an important risk factor for pathological changes in the brain, while overweight or mild obesity may be inversely associated with cortical atrophy in cognitively normal elderly males.

Association of cardiovascular health screening with mortality, clinical outcomes, and health care cost : A nationwide cohort study

Lee, H., Cho, J., Shin, D. W., Lee, S. P., Hwang, S. S., Oh, J., Yang, H. K., Hwang, S. H., Son, K. Y., Chun, S. H., Cho, B. L., & Guallar, E. (n.d.).

Publication year

2015

Journal title

Preventive Medicine

Volume

70

Page(s)

19-25

10.1016/j.ypmed.2014.11.007

Abstract

Abstract

Objective: To determine whether a cardiovascular disease (CVD) health screening program is associated with CVD-related health conditions, incidence of cardiovascular events, mortality, healthcare utilization, and costs. Methods: Cohort study of a 3% random sample of all Korea National Health Insurance members 40. years of age or older and free of CVD or CVD-related health conditions was conducted. A total 443,337 study participants were followed-up from January 1, 2005 through December 31, 2010. Results: In primary analysis, the hazard ratios for CVD mortality, all-cause mortality, incident composite CVD events, myocardial infarction, cerebral infarction, and cerebral hemorrhage comparing participants who attended a screening exam during 2003-2004 compared to those who did not were 0.58 (95% CI: 0.53-0.63), 0.62 (95% CI: 0.60-0.64), 0.82 (95% CI: 0.78-0.85), 0.84 (95% CI: 0.75-0.93), 0.84 (95% CI: 0.79-0.89), and 0.73 (95% CI: 0.67-0.80), respectively. Screening attenders had higher rates of newly diagnosed hypertension, diabetes mellitus, and dyslipidemia, lower inpatient days of stay and cost, and lower outpatient cost compared to non-attenders. Conclusions: Participation in CVD health screening was associated with lower rates of CVD, all-cause mortality, and CVD events, higher detection of CVD-related health conditions, and lower healthcare utilization and costs.

Association of ferritin elevation and metabolic syndrome in males. Results from the Aragon Workers' Health Study (AWHS)

Ledesma, M., Hurtado-Roca, Y., Leon, M., Giraldo, P., Pocovi, M., Civeira, F., Guallar, E., Ordovas, J. M., Casasnovas, J. A., & Laclaustra, M. (n.d.).

Publication year

2015

Journal title

Journal of Clinical Endocrinology and Metabolism

Volume

100

Issue

5

Page(s)

2081-2089

10.1210/jc.2014-4409

Abstract

Abstract

Context: Ferritin concentration is associated with metabolic syndrome, but the possibility of a nonlinear association has never been explored. Objective: This study aimed to examine the relationship between serum ferritin levels and the metabolic syndrome in Spanish adult males. Design: This was a cross-sectional analysis of baseline data from the Aragon Workers' Health Study. Setting: Healthy workers from a factory were studied during their annual checkup. Participants: Spanish male adults (n = 3386) between the ages of 19 and 65 years participated. We excluded participants with ferritin > 500 μ/L, ferritin < 12 μg/L, or C-reactive protein > 10 mg/L. Main Outcome Measure: Metabolic syndrome was defined according to the 2009 consensus definition from the Joint Interim Statement of several international societies. Results: Metabolic syndrome prevalence was 27.1%. We found a positive association between elevated iron stores, measured as serum ferritin concentration, and metabolic syndrome and its criteria. Participants within the highest serum ferritin quintile had a higher risk than those in the lowest quintile for central obesity (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.46-2.42), hypertriglyceridemia (OR, 2.15; 95% CI, 1.69-2.74), and metabolic syndrome (OR, 1.92; 95% CI, 1.48-2.49). The association was nonlinear and occurred at serum ferritin concentrations > 100 μg/L (∼ 33th percentile). Ferritin was also associated with insulin resistance, measured by homeostatic model assessment-insulin resistance (HOMA-IR) (P trend < .001). Conclusions: Our findings suggest that serum ferritin is significantly associated with metabolic syndrome and its criteria (especially central obesity and hypertriglyceridemia), suggesting that ferritin could be an early marker of metabolic damage in the development of metabolic syndrome.

Baseline Troponin T Levels Modulate the Effects of ICD Shocks on All-Cause Mortality

Nauffal, V., Zhang, Y., Blasco-Colmenares, E., Spragg, D. D., Marine, J. E., Butcher, B., Norgard, S., Guallar, E., Tomaselli, G. F., & Cheng, A. (n.d.).

Publication year

2015

Journal title

Journal of the American College of Cardiology

Volume

66

Issue

25

Page(s)

2911-2912

10.1016/j.jacc.2015.10.048

Abstract

Abstract

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Brachial-ankle pulse wave velocity is associated with coronary calcium in young and middle-aged asymptomatic adults : The Kangbuk Samsung Health Study

Cainzos-Achirica, M., Rampal, S., Chang, Y., Ryu, S., Zhang, Y., Zhao, D., Cho, J., Choi, Y., Pastor-Barriuso, R., Lim, S. Y., Bruguera, J., Elosua, R., Lima, J. A., Shin, H., & Guallar, E. (n.d.).

Publication year

2015

Journal title

Atherosclerosis

Volume

241

Issue

2

Page(s)

350-356

10.1016/j.atherosclerosis.2015.05.031

Abstract

Abstract

Objective: To evaluate the association between brachial-ankle pulse wave velocity (baPWV), a convenient, non-radiating, readily available measurement of arterial stiffness, and coronary artery calcium (CAC), a reliable marker of coronary atherosclerosis, in a large sample of young and middle-aged asymptomatic adults; and to assess the incremental value of baPWV for detecting prevalent CAC beyond traditional risk factors. Methods: Cross-sectional study of 15,185 asymptomatic Korean adults who voluntarily underwent a comprehensive health screening program including measurement of baPWV and CAC. BaPWV was measured using an oscillometric method with cuffs placed on both arms and ankles. CAC burden was assessed using a multi-detector CT scan and scored following Agatston's method. Results: The prevalence of CAC > 0 and CAC > 100 increased across baPWV quintiles. The multivariable-adjusted odds ratios (95% CI) for CAC > 0 comparing baPWV quintiles 2-5 versus quintile 1 were 1.06 (0.87-1.30), 1.24 (1.02-1.50), 1.39 (1.15-1.69) and 1.60 (1.31-1.96), respectively (P trend < 0.001). Similarly, the relative prevalence ratios for CAC > 100 were 1.30 (0.74-2.26), 1.59 (0.93-2.71), 1.74 (1.03-2.94) and 2.59 (1.54-4.36), respectively (P trend < 0.001). For CAC > 100, the area under the ROC curve for baPWV alone was 0.71 (0.68-0.74), and the addition of baPWV to traditional risk factors significantly improved the , and calibration of models for detecting prevalent CAC > 0 and CAC > 100. Conclusions: BaPWV was independently associated with the presence and severity of CAC in a large sample of young and middle-aged asymptomatic adults. BaPWV may be a valuable tool for identifying apparently low-risk individuals with increased burden of coronary atherosclerosis.